MEDICARE: DR. COLIN LEE OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3879-35	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3879-35	OTHER	WI	LICENSED OPTOMETRIST

General Provider Information

NPI Number	:	1720646193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLIN LEE OD

Provider Business Mailing Address
First Line	:	4300 W LAYTON AVE STE 100
Second Line	:
City	:	GREENFIELD
State	:	WI
Zip	:	53220-4136
Country	:	US
Telephone Number	:	414-928-2020
Fax Number	:	414-210-3402

Provider Business Practice Location Address
First Line	:	4300 W LAYTON AVE STE 100
Second Line	:
City	:	GREENFIELD
State	:	WI
Zip	:	53220-4136
Country	:	US
Telephone Number	:	414-928-2020
Fax Number	:	414-210-3402

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2019
Last Update Date	:	03/09/2026

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